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Bedlam
TX: 21 Nov 2013, Week 47

A brand new four-part series, Bedlam boldly challenges the myths and taboos about mental illness through unprecedented access to the patients and staff of the South London and Maudsley (SLaM) - the world’s oldest psychiatric institution.

Notes to Editors

The word Bedlam can be traced back to 1247 when the Priory of St Mary of Bethlehem was established in the City of London. The priory, which became a refuge for the sick and infirm, was known as ‘Bedlam’ and was the earliest incarnation of what is now Bethlem Royal Hospital, part of the South London and Maudsley (SLaM). ‘Bedlam’ also reflects how mental illness has been perceived historically and while treatment has changed dramatically over the past 800 years, stigma undoubtedly still remains. This series wants to help change that.

In the final episode of Bedlam, cameras gain access to a psychiatric ward for over 65s at the South London and Maudsley (SLaM).

According to psychiatrist, Professor Robert Howard, “In society old people and people with mental health problems come right at the bottom of the heap really. So, if you are old and you have got mental health problems, you have got this sort of dreadful double whammy of disadvantage.”

Professor Howard has been treating 67-year-old Lorraine. She’s forgotten who she is and is unable to recall anything about her past life. It happened almostovernight. Medication is having little effect. Lorraine’s not making progress and the clinical team is unsure how to proceed. It seems she may be suffering from a rarely-seen condition called dissociative disorder – which in the past was known as hysteria. After several months Professor Howard decides on a controversial treatment: ECT, electroconvulsive therapy.

86-year-old Peter has spent his life travelling the world. A year ago he was teaching in Istanbul but his mental state began to deteriorate and he took an overdose after returning to England. He claims it was a cry for help, not a serious attempt on his life, but his psychiatrist disagrees. Peter has schizoaffective disorder, characterised by mood swings and delusional behaviour which includes talking to his right hand. Like many other mental health patients, Peter is adamant that he doesn’t want to take medication.

Vera, 82, used to be a volunteer helper in the community but now can’t look after herself. She’d never had a mental illness before but was admitted to hospital with psychotic symptoms. She’d developed a distorted view of reality and when she came on to the ward believed the doctors and nurses were imposters. Although those symptoms have gone she now suffers from extreme anxiety and is incredibly nervous about the prospect of leaving the ward and returning home. The staff suggest she tries spending a night back her flat on her own but within just a couple of hours Vera panics, requesting to go back. With no family to support her, she’s unsure whether she’ll ever have the confidence to live on her own.

Sylvia was 70 before she first experienced mental illness. She became severely depressed following a series of deaths of a number people very close to her. After being diagnosed with bipolar disorder – in her own words, “I’m not sure what it means. I think it means I’m double nutty!”- she ended up having electroconvulsive therapy treatment (ECT)on the Older Adults Psychiatric Ward at the Maudsley Hospital. Despite the success of the ECT treatment, Sylvia still takes Lithium every day, which helps to stabilise her mood. Two years later, she volunteers every Friday in the ward where she was once treated to chat to the patients and generally help out. Friendly, warm and chatty, Sylvia is an example that recovery is possible.

In this episode we explore the world of the mentally ill who live in the community.

Fifty years ago you'd hardly ever see someone with a mental illness out and about - they were locked away in Victorian asylums.

Today, in south London, almost 10 times more patients are cared for in their homes than in hospital. It's better known as care in the community but our perception of whether it works is often coloured by media reporting of mental illness. The reality is somewhat different.

Cameras join a community mental health team in the borough of Lewisham. Social worker Jim Thurkle and psychiatrist Dr Tom Werner are part of a 20-strong team that look after around 350 mental health patients.

Ultimately, if they can keep them well and stable, these people stay out of psychiatric hospital and enjoy their freedom and independence.

There are more than 1,000 patients in the borough living with psychosis. It means they have a distorted view of reality - they hear voices, experience delusions or hallucinations.

Tamara is a mum of two in her thirties who has persistent delusional disorder. Her house contains bed bugs which the council hasn’t been able to remove. But Tamara believes these bugs are multiplying and have got inside her body, behind her eyes and into places it's impossible for them to reach. When she's getting unwell she starts to sleep in the communal corridors outsider her flat. Earlier in the year she was admitted to SLaM where she was sectioned. This was the first time she was a patient at a psychiatric hospital. She's determined not to go back but her mental health fluctuates by the day.

Rosemary lives with paranoid schizophrenia. Social worker Jim has been trying to make contact with her at home for several weeks but she never answers the door. Around 1 in 3 of Jim's patients often refuse to engage. Rosemary hasn’t taken any medication for at least four months and Jim’s worried she might be about to relapse. Jim continues to try and find her but it becomes apparent that for care in the community to work it requires the willingness and cooperation of patients.

Lloyd, 44, is a former market trader and was once a successful stand-up comedian. He started to develop psychotic symptoms six years ago after two stressful life events: the break-up of a relationship with his long term partner and the death of his mother. Now he hears a voice in his head called Martha. Lloyd has been diagnosed with paranoid schizophrenia. He lives with his dad Ray and neither of them have quite come to terms with what the illness means or how the outside world will view it. Lloyd is afraid of going out and seldom leaves the house. To cope with the anxiety he often turns to alcohol. His psychiatrist is worried about the effect it will have and soon Lloyd's deteriorating general health becomes more of a concern than his mental health.

Episode 2/4: Crisis - Thursday 7th November 2013, 9:00pm, Channel 4

At Lambeth Hospital in south London, the Trust has pioneered the use of short-stay emergency wards for patients in crisis. It's effectively run like A&E but for those with mental illness.

Cameras are granted access for the first time to a world where critical decisions about risk are taken every day by psychiatrists and nurses.

Patients admitted to Lambeth Triage may be considered a risk to themselves or to others. Many come in against their will under a section of the Mental Health Act, others come in voluntarily. They often suffer with psychosis, mania, depression or personality disorder. Some may be here for the first time, others are regulars - revolving door patients who have relapsed.

It soon becomes clear that the people here are high risk. We meet Dominic, a creative director of an IT company and father of four who was found at home by his family after having taken an overdose of painkillers and vodka. He's diagnosed with bipolar disorder but this is his first suicide attempt.

Father of four Dominic isn't sure why he's tried to kill himself and after a few days on the ward feels able to go home but psychiatrist Dr Martin Baggaley isn't sure whether Dominic still poses a risk to himself and his family also worry whether something else could tip him over the edge.

Angelika has flown over to the UK from Germany to meet her fiancé but it appears he doesn't actually exist and that she is suffering from delusional beliefs. Staff try to convince her that she needs to take medication to get better but she refuses.

Katrina is a 22-year-old student at a top drama school who lives with her mother. In her second year at university her life was interrupted by mental illness. She was first diagnosed with schizoaffective disorder at the age of 20 and is now experiencing her third admission to hospital. This time she was admitted to the ward after threatening her mum following an argument over an iPhone.

Episode 1/4: Anxiety - Thursday 31st October 2013, 9:00pm, Channel 4

It’s a condition every one of us experiences from time to time, but imagine if one day you woke up and found your anxiety had spiralled completely out of control.

Anxiety has become the mental illness of our time - the NHS issues around 7 million anti-anxiety drug prescriptions every year - but while most of us are able to live with it, for some it’s completely debilitating.

At the Bethlem Royal Hospital in south London, a specialist anxiety unit treats some of the most extreme cases in Britain - the top 1 per cent. It’s a residential unit, one of only two in the country.

Most suffer with extreme OCD and despite the myths, these are not people who obsess about their houses being untidy. They have a serious mental illness rendering them unable to function, hold down jobs or maintain relationships.

23-year-old James has an unusual anxiety - a profound fear that he’ll lose control of his bowel movements in public. Consequently he spends up to seven hours a day in the loo, too scared to leave in case he has an accident. He’s been in and out of psychiatric institutions since he was a teenager and last year had to drop out of university because his OCD got so bad. His mum, Penny, talks about how she’s lost the little boy she once knew and how she’s desperate for him to live a normal life again.

Helen is a librarian at the British Museum. She has an irrational fear of harming strangers – she believes that somehow she’s responsible for killing them in road traffic accidents or putting them in rubbish bins. For the last two years she’s lived the life of a recluse, too worried to leave the house or go to work. As a result her long-term relationship has broken down.

The rituals and behaviours of people like James and Helen can often seem odd or bizarre but they are driven by a less well known aspect of OCD called intrusive thoughts.

Head of Anxiety Disorders Residential Unit (ADRU) Simon Darnley explains that we all have unwanted involuntary, fleeting thoughts and we are able to dismiss them. His patients, however, become extremely worried and obsess about them. The more they try to ignore the thought, the stronger it becomes. The key to getting better lies in confronting the thoughts head on in practical exercises.

Darnley also highlights how the specific anxieties and worries are a product of our time. In the ‘80s he saw people who were convinced they’d somehow “caught” HIV. More recently the unit has begun to see people who have an irrational fear that they are paedophiles which he believes is a direct result of the media witch hunt around paedophilia.

The unit runs a 12-week therapy programme with a success rate of 3 in 4.

According to Darnley we are all on the scale and any one of us has the potential to become paralysed by our anxiety but he also maintains people can be cured.

Past TX Information

BEDLAM 4/4: Breakdown: Older Adults

25 Nov 2013, 02:35

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The final episode of the series visits a psychiatric ward for over-65s at the South London and Maudsley. According to psychiatrist Professor Robert Howard, 'In society old people and people with mental health problems come right at the bottom of the heap really. So, if you are old and you have got mental health problems, you have got this sort of dreadful double whammy of disadvantage.' Lorraine, who's 67, has forgotten who she is and can't remember anything about her life. It happened almost overnight. Peter, who's 86, has spent his life travelling the world. A year ago he was teaching in Istanbul but his mental state began to deteriorate and he took an overdose after returning to England. Peter has schizoaffective disorder, characterised by mood swings and delusional behaviour. He doesn't want to take medication. Vera, who's 82, had never had a mental illness before she was admitted to hospital with psychotic symptoms. She'd developed a distorted view of reality and believed the doctors and nurses were imposters. Although those symptoms have gone, she now suffers from extreme anxiety and, with no family to support her, she's unsure whether she'll ever have the confidence to live on her own. Sylvia was 70 before she first experienced mental illness. She became severely depressed following the deaths of a number people very close to her. After being diagnosed with bipolar disorder, she had electroconvulsive therapy treatment. Two years later, she volunteers every Friday in the ward where she was once treated, chatting to the patients and generally helping out. Friendly, warm and chatty, Sylvia is an example that recovery is possible. Series Dir: Dave Nath; Prod/ Dir: Becky Lomax; Exec Prods: Amy Flanagan, Jonathan Smith; Prod Co: The Garden Productions